Nevada Revised Statutes
Chapter 695F - Prepaid Limited Health Service Organizations
NRS 695F.220 - Contract between organization and provider or subcontractor for provision of services to enrollees: Required terms and conditions.

Each contract between a prepaid limited health service organization and a provider or other person subcontracting for the provision of a limited health service to enrollees on a prepayment basis or any other basis must contain the following terms and conditions:
1. If the prepaid limited health service organization fails to pay for a limited health service for any reason, including, but not limited to, insolvency or breach of this contract, the enrollees are not liable to the provider for any money owed to the provider pursuant to this contract.
2. A provider, agent, trustee or assignee thereof may not maintain an action at law or attempt to collect from an enrollee any money which the prepaid limited health service organization owes to the provider.
3. These provisions do not prohibit the collection of any uncovered charges which an enrollee agreed to pay or the collection of any copayment from an enrollee.
4. These provisions survive the termination of this contract, regardless of the reason for the termination.
5. The termination of this contract does not release the provider from its obligation to complete any procedure on an enrollee who is receiving treatment for a specific condition for a period not to exceed 60 days, at the same schedule of copayment or any other applicable charge in effect when this contract is terminated.
6. Any amendment to the provisions of this contract must be submitted to the Commissioner for approval before the amendment is effective.
(Added to NRS by 1991, 1118)

Structure Nevada Revised Statutes

Nevada Revised Statutes

Chapter 695F - Prepaid Limited Health Service Organizations

NRS 695F.010 - Definitions.

NRS 695F.020 - "Enrollee" defined.

NRS 695F.030 - "Evidence of coverage" defined.

NRS 695F.040 - "Limited health service" defined.

NRS 695F.043 - "Medicaid" defined.

NRS 695F.047 - "Order for medical coverage" defined.

NRS 695F.050 - "Prepaid limited health service organization" defined.

NRS 695F.060 - "Provider" defined.

NRS 695F.070 - "Subscriber" defined.

NRS 695F.080 - General applicability of title 57 of NRS.

NRS 695F.090 - Applicability of chapter and other provisions.

NRS 695F.100 - Certificate required.

NRS 695F.110 - Application; fee.

NRS 695F.120 - Review of application; issuance of certificate.

NRS 695F.130 - Application of person who is licensed as insurer or holds another certificate of authority.

NRS 695F.140 - Denial of application; hearing.

NRS 695F.150 - Evidence of coverage: Issuance; contents; amendment.

NRS 695F.151 - Organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.

NRS 695F.153 - Evidence of coverage covering prescription drugs: Provision of notice and information regarding use of formulary.

NRS 695F.156 - Evidence of coverage covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of enrollee; exceptions.

NRS 695F.158 - Evidence of coverage covering prescription drugs: Required actions by organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

NRS 695F.160 - Rates and charges: Reasonableness.

NRS 695F.170 - Procedure for modification of rates, charges, benefits, organization, operations, documents or services.

NRS 695F.180 - Investments.

NRS 695F.190 - Requirements for reserve.

NRS 695F.200 - Maintenance of capital account, surety bond or deposit and risk-based capital; determination of amount of increase by Commissioner.

NRS 695F.210 - Maintenance of fidelity bond or deposit in lieu of bond.

NRS 695F.212 - Hazardous financial condition: Regulations; determination; powers of Commissioner.

NRS 695F.220 - Contract between organization and provider or subcontractor for provision of services to enrollees: Required terms and conditions.

NRS 695F.230 - Establishment of system for resolution of complaints.

NRS 695F.300 - Regulations.

NRS 695F.310 - Examinations and investigations.

NRS 695F.320 - Annual report and financial statement; quarterly statement; additional reports; penalties for failure to file report or statement.

NRS 695F.330 - Payment of premium tax.

NRS 695F.340 - Fees.

NRS 695F.350 - Suspension or revocation of certificate of authority: Grounds; notice; hearing; effect.

NRS 695F.360 - Violations of chapter: Order to cease and desist; fine.

NRS 695F.400 - License required to apply, procure, negotiate or place for another any policy or contract of organization.

NRS 695F.410 - Confidentiality and disclosure of information.

NRS 695F.420 - Certain insurers and organizations authorized to exclude coverage duplicated pursuant to this chapter.

NRS 695F.430 - Provision of services excluded from practice of any healing arts; solicitation excluded from provisions regarding solicitation or advertising by practitioner of healing art.

NRS 695F.440 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

NRS 695F.450 - Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is insured.

NRS 695F.460 - Certain accommodations required to be made when child is covered under evidence of coverage of noncustodial parent.

NRS 695F.470 - Organization required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

NRS 695F.480 - Organization prohibited from restricting coverage of child based on preexisting condition if person who is eligible for group coverage adopts or assumes legal obligation for child.